What is the best medicine for obsessive-compulsive disorder

Obsessive-compulsive disorder

Obsessive-compulsive disorder (Obsessive-compulsive disorder, obsessive-compulsive disorder): Obsessive-compulsive disorders are intrusive, stereotypically recurring thoughts and actions that are experienced as meaningless and disturbing, but cannot be suppressed and have a significant impact on everyday life. About 2% of the population are sick. Obsessive-compulsive disorder, along with phobias, are the most common form of neurosis and can be easily treated with behavioral therapy.

Leading complaints

  • Obsessive thoughts are thought contents, i.e. images, ideas, ideas, impulses or fears, which are recognized as nonsensical, but can neither be ignored nor suppressed and repeatedly imposed. The most common thoughts and fears are e.g. For example, that your own health is endangered, that you could get dirty or that you have constant doubts about having done or failed to do something (“Is the iron still on or have I turned it off?”).
  • Compulsions are activities, behaviors and rituals that someone has to do again and again against or without their will, although they are mostly perceived as exaggerated and pointless. The most common is the compulsory control, followed by the compulsory washing or collecting. If the person concerned is prevented from doing the compulsive act or if he tries to turn it off himself, fears and unbearable inner tensions build up. In severe cases, the compulsions rob those affected of all their energy and lead to the fact that they are no longer able to work and can no longer leave the apartment.

Most of the time, obsessions and compulsions occur together. Because of their perceived hopeless situation, the patients often suffer from depression and anxiety disorders.

When to the doctor

In the next few days if the complaints impair everyday coping or negative consequences (incapacity for work, conflicts in family and partnership) are feared or have already occurred.

The illness

Compulsions mostly develop in people who are fearful, cautious and socially withdrawn and shy. The cause is often an overstrained situation, traumatic experiences can also be involved (post-traumatic stress disorder). The following factors play a role in the development of the disease:

Inheritance. Children of compulsive parents become ill more often than children of “normal” families. However, whether this speaks for a genetic transmission of the disease is controversial. Just as plausible is the explanation that children “copy” or “learn” the compulsive behavior from their parents.

Neurobiological factors. Obsessive-compulsive patients show overactivity in certain parts of the brain. This leads to communication problems between the frontal brain and deeper brain structures (basal ganglia). In addition, a deficiency of the messenger substance serotonin was found in obsessive-compulsive patients. That is why patients respond well to drugs that increase serotonin levels (SSRIs).

Education. Psychoanalysis assumes that too early and excessive cleanliness training in toddlers can later lead to obsessive-compulsive disorder. However, this assumption could not be supported by scientific studies. What is certain, however, is that a parenting style that rewards order, cleanliness and flawlessness very strongly and punishes deviations accordingly, favors obsessive-compulsive disorder.

Stress, strain. Most of the time, the disease is preceded by a burden that the patient with his high demands on himself no longer feels able to cope with. For example, a mother sometimes perceives her newborn baby, who often screams at night, as a burden - but as the “perfect mother” she must not admit this to herself. The heavy load then comes z. B. Expressed through compulsive behavior or aggressive fantasies.

People with Obsessive Compulsive Disorder tend to be very conscientious, accurate, and orderly. They hate taking risks and are almost over-conforming to social norms and rules. The tendency to this fearful, adjusted, overly precise behavior is often already evident in childhood, but at the latest in early adulthood. The transition between "normal", very precise, considered and careful behavior and compulsion is fluid. The sick notice that they - against their will - spend more and more time and energy on their rituals and experience them as very tormenting. Compulsive acts usually also serve to ward off fear: The fear suddenly stops as soon as the compulsive act is carried out. This “reward” of compulsive behavior keeps the compulsion upright. In contrast to an addiction, the compulsive behavior only provides relief for a short time and is not experienced as a reward. In obsessive-compulsive disorder, the patient experiences himself as the originator of the symptoms. The obsessional phenomena are not given to him from outside, as is the case with a psychosis. Nevertheless, the person concerned does not manage to tackle the internal compulsion or to overcome it.

Forms of coercion

39-year-old woman with compulsory washing who had existed for at least four years. Although she was now suffering from "washerwoman's hands", i. H. had painful eczema on her hands, she could not reduce her washing rituals. The beginning of the therapy was difficult: Since the patient did not believe in success, she stopped the behavior therapy. After being admitted to a dermatological clinic because of her eczema, she tried again and was cured.
Georg Thieme Verlag, Stuttgart

  • Who at a Compulsory washing has to scrub his hands and shower dozens of times a day. Shortly after the ritual, those affected feel again that they are dirty. As a result of the many washes, which are usually done with aggressive soaps and brushes, the skin tears and becomes inflamed.
  • At a Compulsion to control those affected have to convince themselves again and again that they are z. B. have switched off the stove or the iron before leaving home. As soon as they are at the apartment door, however, they have doubts again and they have to check everything again. This can be repeated many times. If the patients finally manage to leave the apartment, they torture their fantasies that they might have overlooked something.
  • At the Repetition compulsion the person concerned repeats certain rituals (compulsively) so that a bad fear does not arise; z. B. each light switch must be touched three times so that the partner does not fall ill. With compulsory counting, certain objects (the windows of houses, stepping stones on the sidewalk) have to be counted over and over again.
  • Compulsive perfectionism at work means that those affected have to keep checking whether they have worked flawlessly or whether they could still improve something. They often take work home and work a lot of overtime without actually doing their job. At the same time, those affected are permanently exhausted, nervous and tense. In the end, the manager often doubts the performance, which leads to professional problems.
  • If violent or obscene topics are in the foreground, one speaks of Forced pulses: Those affected suffer from the fantasy of having to swear at colleagues or superiors, and cannot get disgusting sexual ideas or frightening thoughts out of their heads. Often the content of the obsessional ideas contradicts one's own norms and values ​​- a religious person is plagued by blasphemous thoughts, someone who is sexually reserved with pornographic profanity. The social control is almost always preserved, so the impulses are not implemented in reality.

That's what the doctor does

Often those affected come with other main complaints such as B. Depression into practice. However, the experienced doctor quickly succeeds in carefully questioning the surface of the depressive symptoms described to the obsessive-compulsive symptoms behind them.

Until 20 years ago, obsessive-compulsive disorder was considered very difficult to cure. Modern psychotherapeutic methods, especially cognitive behavioral therapy - in severe cases initially combined with psychotropic drugs - have led to an almost revolutionary breakthrough in obsessive-compulsive disorder with healing rates of over 80%. The earlier the therapy starts, the better the prognosis. But diseases that have existed for years or decades can also be successfully treated with modern therapy methods.

In severe cases and with a long-standing, chronic disorder, inpatient treatment in a special clinic is recommended to start therapy. However, since many compulsive acts are also tied to the home or the job (e.g. control obligations), the inpatient stay should always be followed by further outpatient treatment.

Psychiatric drugs. Psychopharmacologically, therapy is carried out in severe cases with antidepressants, mostly with serotonin reuptake inhibitors (SSRIs). Neuroleptics are only used when the patient is very restless and fears or depressive symptoms are in the foreground.

If there is no response to drug therapy with psychotropic drugs, this therapy should be discontinued after 6 weeks at the latest and cognitive behavioral therapy with exposure and reaction management should be offered instead:

Psychotherapy. Compulsions speak best to them Exposure therapy on, a form of cognitive behavioral therapy. The affected person is prevented from exercising his or her compulsive act - of course with his or her consent and after a detailed explanation of the treatment concept. He may z. B. does not wash his hands or has to leave his home without a control check. In cognitive behavioral therapy, disturbed thought patterns and irrational assumptions are questioned and gradually replaced by more useful thought patterns.

Your pharmacy recommends

The patients are mostly ashamed of their illness and believe that they can get a grip on it if they just “pull themselves together”. You then get into a vicious circle of frustrating experiences and an intensification of the complaints. There are self-help groups for those affected and their relatives to exchange ideas about the illness and how to deal with an impending relapse. Constant preoccupation with compulsions can also have a negative impact on the disease. Often it helps those affected more to distract themselves from their compulsions. The best precaution therefore consists in varied, interesting activities.

The environment often suffers almost as much from the constraints as the patients themselves. Even if it is difficult: relatives should ask the patient for therapy. All attempts to explain to him that his fears are irrational and that his controls are exaggerated come to nothing. Because those affected know that themselves, but they still cannot do otherwise. In addition, the symptoms should be paid as little attention to as possible. Because every attention reminds the patient of his compulsion, even when the illness may not be in its power.

Further information

  • www.zwaenge.de - Website of the German Society for Obsessive Compulsive Diseases e. V. (DGZ, Osnabrück): With addresses of psychotherapists, clinics and self-help groups. Offers the opportunity to request free brochures.
  • www.christoph-dornier-klinik.de - website of the clinic of the same name in Münster with well-founded information about the disease, its causes and therapy.
  • H. Ambühl: Ways out of compulsion. How to understand and overcome obsessional rituals. Patmos, 2004. The psychotherapist Ambühl describes the disease comprehensively and comprehensibly and uses case studies to explain various treatment options.
  • G. Gielen et al .: I overcome my compulsion. Confronting the need to wash Pabst Science Publishers, 2005. The book describes in particular what the patient can expect in inpatient therapy.
  • Ulrike S. et al .: The way out of obsessive-compulsive disease. Vandenhoeck & Ruprecht, 2003. Very personal report from a victim.

Authors

Gisela Finke, Dr. med. Astrid Hacker, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 17:06


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.